CSU

Chronic Spontaneous Urticaria: Treatment Approaches and Clinical Evidence

This collection examines chronic spontaneous urticaria (CSU), a debilitating skin condition characterized by recurrent wheals, angioedema, and pruritus lasting more than 6 weeks. The documents reveal a comprehensive treatment landscape centered on up-dosing second-generation antihistamines as the primary therapeutic strategy.

Key Treatment Insights

• Up-dosing efficacy: Studies demonstrate that increasing antihistamine doses up to 4x standard amounts (and beyond) provides symptom control in 49-70% of previously unresponsive patients
• Drug-specific evidence: Fexofenadine, levocetirizine, cetirizine, and bilastine show varying degrees of success, with bilastine demonstrating superior tolerability profiles
• Safety profile: Side effects remain manageable even at high doses, primarily limited to mild sedation and headache

Clinical Reality

CSU affects 0.5-1% of the population, predominantly working-age adults (20-40 years), with significant quality-of-life impacts including sleep disturbances and work impairment. Despite straightforward diagnostic criteria, patients often experience diagnostic delays. The condition's autoimmune mechanisms remain poorly understood, though IgE autoantibodies and thyroid associations have been identified.

Treatment Evolution

While traditional approaches focus on symptom management, emerging therapies including biologics (omalizumab, ligelizumab), BTK inhibitors, and anti-IL5 antibodies represent the future of CSU treatment for refractory cases.